Saturday, May 29, 2010

Pfizer, Pfrauds and Pfools

Profits leap with price-gouging, upcoding, and medically unecessary products!

Yesterday morning I booted up the computer and got an unsolicited full-on email screed from someone I did not know, who had never communicated with me before.

Mark Tye wrote:

You are pretty quick to generalize an entire profession with your loose OPINIONS. You have described less than 10% of the veterinary profession in your rant. Most veterinarians are honest hard-working people who give away way too much, work way too long, for WAY too little.

Eh? Who was this person, and what was he on about?

From reading his stream-of-consciousness email (it went on for several paragraphs), it appears he had just stumbled on a fact- and link-filled post on this blog called Veterinary Trade Says It's Time to Rip-off the Rubes.

Ah! Good. Glad someone is reading the internets!

Mark Tye, of course, called me a pinhead and an ignorant but provided no links and no facts to back up his own ... (wait for it!) ... opinion.

I had provided links to trade publications, documented pharmacy kickbacks to trade associations, and provided PowerPoint instruction sheets from the industry on how to price-gouge, upcode and suggest the medically unnecessary. Most readers of this blog know I am not short of evidence!

And what did Mark Tye have to support his contention that all was sweetness, light, and high moral fiber in the world of veterinary care?

Not. a. thing.

Nor did he explain his own passionate interest in the subject matter at hand.

Much amused I fired back a short note:

Why don't you Google my name and "pharmaceutical fraud" and see what you come up with?

Good luck on your travels. You are clearly very new to the show.

Not smart enough to take a hint and leave well enough alone, Mark Tye fired back.

I have forgotten more about this industry than you know. Why don't you go spend a few years (or 10) getting to know something about the people that make up this industry.

Much amused I fired off another email:

Why don't you tell me all about yourself?

Ten years! Wow. I am floored.

And you have a hotmail account too!

Yes I was being a little sarcastic.

I have spent a little more than 10 years in health care, and a little more than 10 minutes in the world of dogs!

And a hotmail account? Hillbilly, please!

Who was this fool?

A few seconds after asking the question, I had the answer, and I nearly spilt my coffee I was laughting so hard.


I fired off a short email to Mr. Tye:

Never mind. I found you.

Area sales manager at Pfizer Animal Health in Texas for 6 years.

You think that's a lot of experience??

Formerly a recruiter at Matrix Resources and a sales manager at Ed Kellum & Son.

Graduate of Oklahoma Baptist University.

Not much.

Shall I find out what you sell, and write about how you sell it?

Pfizer is a shit company that just got nailed for the largest criminal and civil fines in U.S. history.

Google my name and Pfizer, and see what you get.

You still want to play?

A Pfizer Animal Health rep is lecturing me about health care ethics?


For the record, Pfizer was nailed last year for the largest criminal and civil fraud charges in U.S. history.

As I told Reuters at the time, "What you see here is a company which essentially has a culture of corruption."

And it's not like Pfizer has only been nailed for fraud once, is it?

Along with record fines for illegal marketing and illegal kickbacks which were paid to increase the sales of Bextra, Pfzer has also been nailed for illegal promotion and/or kickbacks for Geodon (an anti-psychotic drug), Lipitor (a cholesterol drug), Norvasc (an anti-hypertensive drug), Viagra (an erectile dysfunction drug), Zithromax (an antibiotic), Zyrtec (an antihistamine), Zyvox (an antibiotic), Lyrica (an anti-epileptic drug), Relpax (an anti-migraine drug), Celebrex (an anti-inflammatory drug), and Depo-provera (a form of birth control).

Add in to the mix previous settlements for the illegal marketing of the epilepsy drug Neurontin ($430 in criminal and civil penalties), another settlement for more illegal Lipitor sales ($49 million in civil fines), and illegal marketing of human growth hormone Genotropin ($34.7 million), and the words "continuing criminal conspiracy" spring to mind.

And now a Pfizer salesman wants to lecture me on veterinary drug sales?

Oh joy and mirth!

Your Daily Dose -- now fortified with irony.

Since a salesman for Pfizer Animal Health was stupid enough to shoot me a "nasty gram" email to my home, I figure I might as well go ahead and use his résumé and his company's already soiled name to illuminate how pharmaceutical sales work in general, and how veterinary pharma sales work in particular.

I've got to write about something after all, and it's been a while since I beat this particular drum.

To begin, let's look at Mark Tye's experience.

He is a graduate of Oklahoma Baptist University with a degree in Spanish.

No science background at all.

In fact this is normal in pharmaceutical sales, and for a reason.

As filmmaker and former pharma sales rep Kathleen Slattery-Moschkau explains:

When I first came to work for [pharma companies] I was 23 and a year out of college. I majored in political science. That was my “science background.”

I really avoided science like the plague as an undergrad; it was just not my strength. I went to work for the cellular phone industry right out of college selling phones for about a year. Then one day I got a call from a recruiter who had asked me if I had ever considered pharmaceutical sales. I said “No, I don’t have a science background.” He basically said that they can teach you all that you need to know. They’re just looking for someone with sales experience....

When I look back, I think [the lack of any science background] is part of the reason that they recruit people like me – political science majors, history majors, business majors – because I didn’t have the ability to question anything they told me.

I can’t tell you how quickly I could get in over my head if I was talking with a physician about these things. Although I might have known a specific amount about my specific pill or a specific disease stage, once the doctor started asking questions outside of that, I would start to glaze over.

The typical course of my day would be going out, driving around to different physician’s offices, making appointments, and schlepping in a lot of food.

We used to joke that you don’t even need a political science degree for this job; you need a professional caterer’s license.

Mark Tye fits this mold perfectly.

While he claims vast experience and deep knowledge it's mostly bluff, bluster and bunk.

His real background is just 6 years and four months in veterinary sales, and for a single company.

Mark Tye's first job out of college was as a regional sales manager for a consumer finance company (June 1986-April 1991). His next job was as a sales manager for a consumer electronics concern (April 1991-December 1999), and after that he worked as a recruiter for an information technology company (December 1999 to December 2001). He then worked in sales for his family's document copying company (December 2001 to February 2004), before being hired on at Pfizer.

Nothing wrong with any of this, but let's be clear; Mr. Tye's expertise is in separating people from their wallets. It's not dogs, it's not cats, and it's certainly not health care policy, law, ethics or economics!

So that's Mr. Tye, and the company he works for.

Now what about his division, and the products they sell?

Pfizer Animal Health has a lot of products, and I don't have the time or energy to go through all of them, but I'm going to look at a few products targetted to dogs so you can get a general idea of how it goes.

One of Pfizer's main sales products is Rimadyl. As I have noted in a previous post, Rimdayl is a COX-2 drug, and most of the COX-2 drugs like Bextra (see previous mention of Pfizer's record criminal and civil fines) and Vioxx were pulled from the market after they proved to be harmful (Vioxx, to put a point on it, may have killed over 25,000 people in just four years according to the FDA).

Pfizer Animal Health's COX-3 drug, Rimadyl, (aka Carprofen) is not approved for human use because it has so many serious side effects it could not compete against the other COX-2 drugs in the human market, and this was even before those other COX-2 drugs were withdrawn from the market.

But don't take my word for it. The Wall Street Journal reported on March 13, 2000 that "Most Arthritic Dogs Do Very Well On This Pill, Except the Ones That Die".

Except the ones that die?

Woops! I'll bet that's an article that never made it into Mark Tye's veterinary sales kit!

For the record, my objection to Rimadyl is not that it might kill your dog (a very low chance), but that it is unnecessarily expensive due to Pfizer and veterinay practice price-gouging, and because it requires an expensive visit to the vet for a prescription.

For the record, COX-2 drugs have never been proven to be better than common COX-1 drugs (i.e. NSAIDs) such as Aspirin and Ibuprofen. They are simply more expensive and less safe for dogs (cats are a different issue), and NO, they are not gentler on the stomach than buffered aspirin.

Knowing that, why would anyone dose a dog on Rimadyl?

Of course there is an answer, but it's not an answer that Mark Tye or any veterinarian wants you to hear.

That said, if you know where to go, you can hear it being said and see it too.

At a Pfizer-specific online bulletin board for veterinary sales representatives, for example, someone wrote in to note that "A family member of mine paid $58 for 6 pills and they were Rimadyl and I work for [Pfizer Animal Health], so I know that these mark-ups can go this high."

Right. Point made, and by a Pfizer Animal Health employee to boot! Nice.

Another drug being sold by Pfizer is "Slentrol." This is the drug you are supposed to give your pet if it is obese.

What??! We are supposed to be drugging our dogs because they are obese??

Anyone else see a problem here? Gina Spadafori over at Pet Connection did.

She notes that obesity in pets is a human problem, not a pet one, and that the cure is not drugs for the dog, but self-restraint on the part of the owner.

Want to save yourself $2 a day? Take a walk with your dog (it’s good for you both), or play with your cat. Cut back on the treats. Use the tried-and-true trick of substituting shredded green beans for some of the volume in your pet’s dish, and steel yourself against begging.

Excellent advice!

But, of course, it's not the kind of advice you are going to get from a Pfizer Animal Health sales representative struggling to make his or her quota, is it?

Another drug marketed by Pfizer is Convenia. As I noted in a previous post:

[This] drug is a one-time injection which provides up to 14 days of antibiotic treatment for common skin infections.

The injection must be administered by a veterinarian, which will cost you about $80 for the visit.

What neither a vet nor Pfizer will tell you is that you can get cephalexin to treat skin infections at a fraction of the cost and without a visit to the vet or a prescription.

Shhhh! Tell no one!.

OK, so Pfizer's sales force has its full share of fools, the company has embraced a culture of corruption, and at least some of the products are crap.

But what about the veterinarians? Surely they are all models of cost containment, self-restraint and probity?

Well some are, but certainly not all of them!

As I have noted in the past, vetererinary ethics are about the same as you will find in any poorly regulated trade with few consumer protections, and a public that is not too sure of what it is that they are actually buying.

Are all vets price-gougers, bill padders, and flim-flammers?

No, of course not!

That said, all vets are human, and they are not any more (or less) honest than car mechanics, human doctors, or anyone else.

Caveat emptor with all vendors, and especially when you are being "handled" by a "vet tech" or receptionist whose job description is to set you up for "additional services."

To be clear: these front-office people know next to nothing, and generally have been hired to give the real veterinarian cover in case the client calls "bullshit" to the veterinary equivalent of "Can I Super-Size your meal?"

A word to the wise should be sufficient: use Google to get informed and cut costs, do as much basic veterinary stuff as you can yourself, and negotiate pricing with the veterinarian, not the receptionist.

Finally, never forget the best money-saving advice ever, in terms of canine care: Breed choice matters a hell of a lot.

For more on that, read Making and Breaking Dogs In the Show Ring and peruse the canine health links in the blog roll at the right.

Once again, you do not have to take my word for anything.

A reader of this blog is a veterinarian, who left the retail vet trade to work in the regulatory arena. As Sara B notes in A Vet Writes About the Veterinary Business Model:

About five years ago, I was a young enthusiastic new grad and I was looking forward to serving my patients and clients. Instead I was constantly reprimanded for not adhering to 'protocol'. I was chastised in front of the staff for scripting out medications to local human pharmacies where I knew my clients would get a financial break for drugs that were exactly the same as those on our shelves. I didn't always want to use the laser for surgeries. I told people to purchase bottles of goat Panacur at the local farm & barn store instead of selling them pricey Drontal Plus tablets. I didn't recommend the Lyme vaccine. I didn't vaccinate everyone every year for distemper. I will surely burn in hell for mentioning the use of ivermectin rather than selling boxes of HWP to my beagle & coonhound kennel clients. I constantly spent too much time talking with the clients in each appointment. I would "give away" recheck exams. I didn't really care what brand of food people fed their pets (Most of the time they were being fed too much anyway!) And, most egregiously, I was forever giving away nail trims.

Now to be clear, good honest vets DO exist, and you CAN find them if you look.

But as I noted in the very blog post that seems to have gotten Mark Tye's underwear in a knot, the best thing any of us can do to contain costs and push back on chiseling corruption is to begin doing a few things ourselves.

Above all, we can stop going to the vet for “well pet” visits and unneeded shots.

We can end the yearly teeth cleaning nonsense, and take control of end-of-life decisions.

We can give our pets their own vaccines.

We can worm our own dogs, and we can stop giving heartworm medicines all winter long.

We can treat our own dogs for Lyme disease, and stop the testing altogether.

We can stop buying "diet” dog foods from the vet and start feeding less.

We can learn more about cruciate ligament injuries and be a little less quick to operate at a cost of $3,000 per leg.

And, of course, the most important thing we can do is find an honest non-price gouging veterinarian.

They exist within 15 miles of all of us if we will only take the time to research and look.

THIS is heretical information?!

Apparently it is if you are a salesman working for Pfizer Animal Health!

Caveat emptor!

Get your own Pfraud t-shirt here!


woodsman said...

Nice.... "people in glass houses......"

The Suburban Bushwacker said...

Game, set and match to PB

Seahorse said...

Another victim of "The Google"...

Seahorse ;)

creynolds said...

:) oops

HTTrainer said...

What's next, is Mr. Tye going to go back to the home office for support? Or will they hang him out to spin in the wind?

Jonathan Setter said...

This post must be the swift sword of justice you wrote of in your last post. Ouch.

Rick said...

I wonder if Mr Tye still has a job when he returns to work next week.

PBurns said...

Mr Tye is guilty of only two things: 1) poor messaging to someone he did not know and did not investigate even after being warned, and; 2) being a very good parrot capable of repeating back every "this is why veterians need to rip off their customers" talking point that came out of a Brakke consulting firm study penned by .... (wait for it!) ....Bayer Animal Health (another pharmaceutical company).

In fact, as I will show in the next day or two, the pharmaceutical companies are now doing for veterinary care what KPMG and Ernst and Young did for the human health care industry in the 1990s: Showing them how to upcode, how to sell medically unnecessary goods and services, and how to bill pad, while all the time providing a trumped-up reason for them to do so ("you deserve it, and if you don't take their money someone else will," etc.)

For me, writing about this kind of stuff is a "bus man's holiday." That said, this post is really not about Mr. Tye or even Pfizer; it's about how the bigger game is played with sock puppets and parrots like Mr Tye, and veterinary drug companies providing the talking points, and billions of dollars being hoovered out of the pockets of pet-owning consumers as a consequence.

Is Mr. Tye a liar, thief and cheat? I have no knowledge of that, and I am not going to look for more unless he actually pisses me of (and NO, I am not there yet, I assure you). All I know for certain is that Mr Tye has a causal relationship with the truth. That's a pretty common failing, and not that remarkable, is it?

As for Pfizer, their reputation precedes them, but even here let me stress this point: drug companies DO make products that can be life-changing. This is magic in a bottle, and I am a HUGE supporter, and I WANT them to make a profit.

But there is a difference between making a profit and profiteering, and the difference is dosage.

As with so many things, a little is a cure, while a lot is a poison.

Caveat emptor!


Viatecio said...

Terrierman 1, Mark Tye 0

It's amazing how many of your great posts aren't as much about dogs as much as they are more indirectly related or able to be tied back to them somehow.

This is indeed one for the ages and the archives.

Bartimaeus said...

Just to add a veterinarian's perspective on Pfizer, I have found them to be one of the least pleasant drug companies to deal with. They tend to make returns difficult, and have minimum $ amounts for orders that sometimes make things difficult for small one or two vet clinics. At least in my area, the reps are more interested in playing golf with the big boys in Las Vegas or Phoenix, so I have not seen one or had to suffer through a visit in years. It is true that all sales reps are interested in increasing sales, and the science backing up their products needs to be regarded skeptically, but Pfizer seems to have little regard even for many veterinarians (at least the small ones who don't order thousands of dollars worth of unneeded drugs).

The Dog House said...

WOW... that was an online beatdown unlike any other...

Had me giggling, that's for sure.

I have a few questions though, if you have a minute Patrick.

You mention that Rimadyl (and drugs in this class) are no more effective than buffered Asprin. Can I ask for further details?

I have a client whose dog has a luxating patella - he's a rescue, he's 10, he's not in the best health and surgery really isn't an option. I've recommended a few natural products that have given him some relief, but nothing like I've seen with Rimadyl. However, I'm not comfortable with Rimadyl's side effects.

Secondly, with the OTC antibiotics - with all the fraud that goes into other pet supplements, how are you sure that you're getting what you're paying for when you purchase fish quality vitamins? Are they subject to the same regulations? I'm concerned about safety - it's not an expensive drug if you get a script, so I just wonder whether it's worth the savings to take the risk. I'm not disagreeing, just inquiring for the future.

As for the weight loss drug, Dr. Khuly blogged about it as well on Dolittler when it came out. Worth a read.

PBurns said...

Sure Dog House ....

Without going into how NSAID's work, the short story is that Vioxx, Celebrex and Bextra (COX2 drugs, the same as Rimadyl) were never found to be more effective analegesics than asprin or ibuprofen. The pitch was that they were gentler on the stomach, a benefit for long-term use in patients (human or canine) who had to take them long-term (i.e. for more than a few weeks). The problem is that Rimadyl and the other COX-2 drugs are ALSO hard on the stomach and they only look "good" when compared to plain aspirin. But when compared to buffered aspirin, buffered aspiron is as good or better on all counts. See >> for more information.

As for ALL drugs and ALL products (not just anitbiotics), how do you know where any of them comes from? Your mechanic puts new brake pads in your car. Who made them? Where? Who certified them? You have no idea. Ditto for everything that you eat, your chainsaw, and the "brand name" drugs you take. You have no idea, and you never will. All you can hope is that good investigators, whistleblowers, and lawyers keep the system relatively clean.

Now about antibiotics in particular, I have good news. We actually DO test these things for efficacy and the test is very sensitive. You see, tropical fish will die if you so much as fart in their water. They have PH issues, temperature issues, diease issues, etc. And the fish are expensive,

When you buy fish antibiotics (fish-flex, fish-mox), you are getting drugs made in massive lots from regular animal anitbiotic companies that have been tested on lots and lots of very expensive fish. An excellent "canary in the coal mine" system if you ask me!

For more information on fish antibiotics for dogs, see my book (a small plug) or this web page on the main web site associated with this blog >>


Seahorse said...

Hell fire, man, PLUG your most excellent book, American Working Terriers! People, click on the Lulu link to the right of these articles, or click this link:

Really, really excellent book in all regards. For the price of a very average meal going straight to your butt, you can have continuing education in your hands. DO IT!

Seahorse :))

The Dog House said...

"You see, tropical fish will die if you so much as fart in their water."

LMAO... alright, you've certainly made a point there.

And extra thx for the aspirin details... will absolutely be paying this forward in the immediate future.

PBurns said...

For the record this Pfizer Animal Health salesman is not likely to get fired because of anything I say. In fact he might get promoted! Remember, at Pfizer fraud and deception is the core business model! That said, Mr. Tye may be facing a larger structural problem in that Pfizer just bought Wyeth and so there will a lot of natural redundancy and layoffs have already begun. In addition, Pfizer's Slentrol drug is NOT selling well. Combine all this with MASSIVE layoffs throughout the industry as the "lie, steal and cheat" business model has begun to fall apart in the human health arena, and I would not want to work for Pfizer Animal Health or Fort Dodge. Look at these numbers if you want to see industry trends >>